Words matter because clarity in words is a part of clarity in thinking, and because some words carry great emotional and symbolic weight, and thus should be not used lightly.” —Jeffrie G. Murphy
When is Trauma?
Traumatic events are distressing, but not all distressing events should be thought of as traumatic. The term trauma has become the descriptor for distress. A google search of the term will net “About 1,770,000,000 results” (6th February 2023).
This popularisation of trauma as the term to describe distress has occurred through “Concept Creep”. Nick Haslam from the University of Melbourne defined Concept Creep in his article “Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology” (2016).
What is Concept Creep
“Concept Creep” refers to the expansion of the definition of trauma to include more experiences and types of experiences over time. More on this later.
Why is this of Concern?
Within the Psychological Sciences the psychology of trauma has had long established constructs that define trauma. Importantly these diagnostic constructs (e.g., PTSD, Acute Stress Disorder, PCBD) are linked to finding the right therapy for a person’s difficulties.
Concept Creep means that what was once considered outside the realm of traumatic experiences may now be included within it. Which may mean that someone who is distressed may not receive a therapy that is most likely to be effective.
For example, what is the best therapy for an employee who has lost their executive director? Yes, losing an executive director in an organization is listed as a traumatic event on some websites.
https://psychedelic.support/resources/know-the-7-types-of-trauma-like-a-psychotherapist/
PTSD and Trauma
“I have suffered a trauma, so I have PTSD”.
PTSD is not synonymous with traumatic experiences. Benjet,et. al. (2016) reported that 70% of people are exposed to experiences which could be described as meeting Criterion A for a DSM-5 diagnosis of PTSD. These experiences include witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury. In contrast to this exposure rate the prevalence rates for PTSD in the general population are between 5 and 10 %. The Criterion A items for PTSD are listed below for your reference.
Criterion A for PTSD
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): Direct exposure. Witnessing the trauma. Learning that a relative or close friend was exposed to a trauma.
Or experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
Where Concept Creep Might Start
Simplifying of Criterion, A for a DSM-5 diagnosis of PTSD by pinning it to distressing events is unhelpful, and potentially where Concept Creep starts. For example, developmental trauma, because distressing events occurred in childhood, relational trauma because the distress was in the context of relationships, and so on.
This list is just some of experiences defined as trauma events or descriptors used to indicate trauma.
| Type 1 trauma | Coercion |
| Type 2 Trauma | Domestic physical abuse |
| Severe illness or injury | Long term misdiagnosis of a health problem |
| Violent assault | Bullying at home at school or in a work setting |
| Sexual assault | Sexual abuse |
| Traumatic loss | Emotional abuse |
| Mugging or robbery | Physical neglect |
| Being a victim of or witness to violence | Overly strict upbringing sometimes religious |
| Witnessing a terrorist attack | Historical, Collective or Intergenerational Trauma |
| Witnessing a natural disaster | Racism |
| Road accident | Slavery |
| Military combat incident | Forcible removal from a family or community |
| Hospitalisation | Genocide |
| Psychiatric hospitalisation | War |
| Childbirth | Vicarious Trauma |
| Medical trauma | Secondary Trauma |
| Post suicide attempt trauma | Little t trauma |
| Life threatening illness or diagnosis | Big T trauma |
| Complex trauma | Loss of a loved one |
| Developmental trauma | Moving to a new house |
| Repetitive trauma | Losing a job |
| Interpersonal trauma | Bullying |
| Emotional trauma | Community Violence |
| Physical trauma | Disasters |
| Sibling abuse | Early Childhood Trauma |
| Childhood emotional abuse | Intimate Partner Violence |
| Domestic violence | Physical Abuse |
| Emotional neglect and attachment trauma | Refugee Trauma |
| Abandonment | Sex Trafficking |
| Verbal abuse | Terrorism and Violence |
| Interpersonal conflict | Traumatic Grief |
| Divorce | Losing a job |
| Abrupt or extended relocation | Infidelity |
| Financial worries or difficulty | Legal trouble |
| Fighting between staff members with no healing following | Losing an executive director |
| Violence in the workplace, death, or serious injury | Major budget crisis leading to lay-offs |
| Major reorganizations | Layoffs, mergers, acquisitions, and downsizing |
| Turnover of senior leadership or sudden loss of key talent | Natural disaster, fire, flood, etc. |
As can be seen there are many and varied descriptors for trauma. Some relate very clearly to what might be considered a Criterion A event. Others do not have a clear relationship to this diagnostic construct. When clients are convinced that their distress is due to a particular term and that term is not related to a construct that has a research base there is no link to therapy choice. More on this below
The Good The Bad and The Ugly
Concept Creep potentially has positive and negative consequences. On one hand, it can lead to greater recognition of the diverse experiences that can cause trauma and an increase in support for those affected. For example, up to 25% of mothers with babies in NICU have PTSD symptoms. The focus in the hospital environment is often on the baby.
On the other hand, it can result in a decrease in the perceived severity of trauma. “Everyone” is traumatised, which could lead to a reduced response to those who have experienced truly traumatic events.
Additionally, Concept Creep may also result in over-diagnosis and medicalization of experiences that may not necessarily warrant a trauma diagnosis.
It may even create a barrier to therapy. As mentioned above if a client believes a particular term represents their distress they may search for “the therapy” for their particular “trauma”. Self-diagnosis via algorithms that self-perpetuate may mean that their distress is never successfully treated. Therapists need to be skilled in communicating their understanding of diagnostic frameworks and treatment modalities to assist clients who have self-diagnosed.
Final thoughts
If psychology is a science, then clarity of thinking should be part of the profession. Psychologists should think about why they are using a particular term and what it communicates. The risk with Concept Creep is that the multitude of terms to describe trauma may cloud the deeper examination of the client’s experience. A deep examination of how the experience meets or does not meet the criteria for a diagnosis leads to formulation and therapy choice.
Clinician’s and their clients may benefit by being aware of what terms they are using and why.
Is the term the client is using for trauma because that is what the internet said. Is the term used because the client believes that the uniqueness of a particular term validates their experience and other terms do not? Is the client using the term because they don’t like diagnostic terms. Does the use of this term mean that “standard therapies” for their symptoms will not work? Why as a clinician might you use some of these terms, does it help with treatment?
And interestingly, we hardly ever see the term post traumatic growth in the trauma discourse?
References
Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., Shahly, V., Stein, D. J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J. M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., Lepine, J. P., … Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological medicine, 46(2), 327–343. https://doi.org/10.1017/S0033291715001981
Haslam N. (2016). Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology. Psychol. Inq. 27, 1–17. 10.1080/1047840x.2016.1082418
https://traumapractice.co.uk/types-of-trauma/
https://www.nctsn.org/what-is-child-trauma/trauma-types
https://psychedelic.support/resources/know-the-7-types-of-trauma-like-a-psychotherapist/
